1356787725 NPI number — REBECCA R MAKOWSKI M.A., LPC-S, NCC

Table of content: REBECCA R MAKOWSKI M.A., LPC-S, NCC (NPI 1356787725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356787725 NPI number — REBECCA R MAKOWSKI M.A., LPC-S, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKOWSKI
Provider First Name:
REBECCA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC-S, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DICK
Provider Other First Name:
REBECCA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356787725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 WESTBROOK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITMORE LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48189-8208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-904-5031
Provider Business Mailing Address Fax Number:
734-402-8928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5840 N CANTON CENTER RD STE 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48187-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-904-5031
Provider Business Practice Location Address Fax Number:
734-402-8928
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401012196 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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